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Individual

JACLYN LUCIANO

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CRNA

Contact information

Practice address
1000 HEALTH CENTER DR, MATTOON, IL 61938-4644
(217) 258-2440
(217) 258-2186
Mailing address
PO BOX 372, MATTOON, IL 61938-0372
(217) 868-2812

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN0000206203
TN
367500000X
Certified Registered Nurse Anesthetist
11697-33
WI
367500000X
Certified Registered Nurse Anesthetist
Primary
209-027772
IL

Other

Enumeration date
09/14/2021
Last updated
10/10/2023
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